Aseptic Meningitis and Infection-Associated Hemophagocytic Lymphohistiocytosis—Rare Complications of Hepatitis A Virus İnfection

Abstract

Case 1: An 8-year-old girl with a prodrome of fever and headache presented with generalized tonic clonic seizures. She had florid meningeal signs. Laboratory investigations revealed elevated liver enzymes. Cerebrospinal fluid had pleocytosis and elevated protein. Immunoglobulin M antibody against hepatitis A virus (HAV) was positive in serum. She recovered without sequelae.

Case 2: A 10-year-old girl with HAV infection developed progressive pancytopenia, coagulopathy, and worsening liver function. She fulfilled the 2009 diagnostic criteria of hemophagocytic lymphohistiocytosis (HLH). She had spontaneous resolution of HLH without immunosuppressive therapy.

Central nervous system involvements of HAV usually resolve without sequelae. HLH following hepatitis A is being increasingly reported and may resolve spontaneously.

Keywords

aseptic meningitis - extrahepatic manifestations - hemophagocytic lymphohistiocytosis - cerebrospinal fluid

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